Why Multi-Tasking on the iPhone OS is not good for Healthcare – Especially for future Electronic Health Record Apps

It looks like the wishes of many iPhone and iPad users are soon to be answered. AppleInsider is reporting the approaching update of the iPhone OS, version 4.0, will include a “full on solution” for multi-tasking. While they acknowledge that there have been at least three previous such reports, this news is apparently from sources with a proven track record of providing reliable information. Unfortunately, there’s not much information on how Apple’s “solution” gets around the issues that had long been cited for the absence of this support – battery life, resource utilization, and security. However, those three factors are critical to the iPhone’s use in clinical practice. And with the growing adoption of mobile interfaces for electronic health records and e-prescribing, these three areas are critical to determining whether the iPhone and iPad will continue to develop as clinical tools. However, even assuming Apple has come up with a way to mitigate the negative effects multi-tasking would have on those critical areas, multi-tasking is a losing proposition for clinicians.

There are certainly a number of potential benefits to clinicians with multi-tasking added to the iPhone. One area is involves mobile electronic health record platforms. Clinicians would gain the ability to cycle from, say, the Allscripts app to review the labs of a patient with a suspected PE to an app like MedCalc to calculate the Wells score. Or perhaps while trying to sort out what that weird lesion on the MRI is, a clinician could cycle on their iPad from eFilm to iRadiology or PubMed to get a better idea of what he or she is looking at.

However, while those are certainly useful capabilities to have, its questionable whether they are even improvements over current practice. For example, take the electronic health record example. If I am entering a note on that patient and then want to calculate a Wells score, as long as the electronic health record app saves my current progress before closing, I can then use whatever other apps I want. Better yet, developers could build those kinds of calculators into the app. A number of electronic health record vendors with iPhone interfaces commented to me at HIMSS that they were planning on integrating Nuance’s Dragon software, or other similar dictation software, into their apps. They could certainly do that with medical calculators – in fact, I’d argue that would be better because it brings these evidence-based tools just one step closer to the clinician.

In addition, whatever Apple’s solution is here, multi-tasking adds unavoidable security risks to the iPhone and iPad. For example, spyware embedded in another app or downloaded from a website by the unsuspecting clinician could then run in the background and pull information off of the electronic health record app. Since these devices could handle sensitive patient information, prescribing of controlled substances, and other processes that require secure operation, multi-tasking at the very least makes it easier for spyware and other viruses to infiltrate the device and cause some big problems.

In addition, whatever Apple does here, the speed and battery life of the iPhone and iPad will be degraded by the addition of multi-tasking. In other words, take away the multi-tasking capability and the device will get longer battery life and faster processing speeds. And when it comes to utilization in medicine, those gains would probably outweigh the benefits that multi-tasking brings to the table.

So while multi-tasking could be a boon to consumers, who would be able to stream music or utilize VoIP services like Skype while responding to emails, medical professionals should be a little more skeptical about this potential addition. Given the choice, its hard to see how the benefits of multi-tasking justify the sacrifices we must make to have it.